What is CBT?

  • Research evidence endorsed by the National Institute for Health and Clinical Excellence (NICE) indicates that CBT works effectively in treating depression and anxiety disorders such as generalised anxiety disorder, obsessive compulsive disorder, panic disorder, health anxiety and posttraumatic stress disorder, psychosis, bipolar disorder, chronic pain, long term medical conditions, chronic fatigue, insomnia and many others.

    You may have come across this type of popular and accessible therapy before but not sure what it entails and whether it can help you.

    CBT looks at how we think about a situation and how this affects the way we feel and act.  When we feel low or anxious we may think or behave in an unhelpful way which exacerbates the intensity of our feelings and we are more likely to feel worse as the result of our thinking and behaviour.  Therefore, changing the way we think and behave can have a positive effect on our mood.

    CBT therapists help clients to identify unhelpful thoughts by asking them what is going through their minds. Many people are more likely to be aware of their mood and what is happening in their bodies (physical symptoms) as opposed to what they are thinking, whilst others are not attuned to their bodies but can capture their thoughts and feelings. CBT teaches clients to understand triggers and how thoughts, feelings, physical symptoms and behaviours interact with each other.

    Another helpful thing to know is that CBT tends to focus on “the here and now” instead of looking at your past.  However, it is useful to make links between the past and present to help clients understand why they formed certain beliefs. For example, if you have been growing up with a critical parent or have been bullied at school, it is understandable that you may have a core belief: I am not good enough.

    From my clinical experience, clients like the CBT because it is practical and collaborative in reaching therapeutic goals. CBT involves homework assignments between sessions to maximise the effectiveness of therapy. For example, your therapist may ask you to keep a diary or do a behavioural experiment such as asking you to test your anxious predictions about something you feel afraid to do.

    The ultimate aim of CBT is to teach you how to become your own CBT therapist, so you can work out your own strategies for tackling problems.  This is understandably empowering and is designed to give clients control over their difficulties. You can find free CBT resources online; I recommend you visit: getselfhelp.co.uk Furthermore, CBT-based self-help books are available to purchase or borrow from your library.

    It is useful to know that CBT can be used in conjunction with anti-depressant medications, which has been prescribed by your GP. I work with many clients who find both modes of treatment very helpful.

    If you feel that CBT may be helpful for you, do not hesitate to discuss it with your GP who can refer you or you can also self-refer. Before starting CBT, I would like to recommend that you check that your therapist is accredited by the British Association for Cognitive and Behavioural Therapies (BABCP). You can find details of all CBT therapists accredited by BABCP online at www.cbtregisteruk.com







Seasonal Affective Disorder

Colder winter days are fast approaching when most of us wish to hibernate and getting out of bed is getting more difficult as we might feel sleepy and cosy under the duvet.

However, for some people winter months become very challenging due to an apparent decline in their mood. The winter season can lead to developing SAD, which is a type of depression that occurs only during winter months.  In the UK, broadly speaking people can start experiencing SAD symptoms from September to November and they can last till March to May depending on the individual and the British weather of course!

Symptoms include the following: sleeping longer than usual and difficulty of getting up, feeling lethargic, experiencing the loss of pleasure or interest in everyday activities and feelings of guilt or despair. Furthermore, symptoms may include overeating, and for some, the weakened immune system can lead to many colds and infections making winter months even more challenging.

Although the exact cause of SAD isn’t fully understood, research shows that changes to the levels of two hormones play a part; namely melatonin and serotonin. The lack of sunlight results in overproduction of melatonin.  This is a hormone that is important for sleep and in winter months the body produces more melatonin compared to summer months thus we tend to sleep more.

In addition, the production of serotonin can be also affected.  This hormone is very important for our mood, appetite and sleep. The lack of sunlight may lead to reduction of serotonin levels and less serotonin in the brain is generally related to depressive moods.

So what can you do to prevent the likelihood of developing SAD?

Firstly, lifestyle adjustments may help, such as getting out as much as possible during the sun light. Exercising, maintaining a healthy diet despite increased cravings for carbohydrates and sugar rich foods and taking vitamin D may also have beneficial outcomes.

For those who experience clinical symptoms of SAD several therapies have been proven to help; light therapy, talking therapies and antidepressant medication.

The light therapy involves a special light lamp that simulates exposure to sunlight and can be used either on its own or in conjunction with other therapies. The light box contains very bright fluorescent tubes, usually 10 times more intense compared to our household lights.  They are available at different sizes and it is advised that for SAD sufferers at least 2500 lux is required to have the desired effect. They are readily available online from many different manufacturers.

Another option you may like to consider is taking St John’s wort; this herbal remedy available over the counter, can be effective for mild to moderate depressive symptoms as an alternative to antidepressant medication.

Lastly, going on holiday to sunny countries during winter months is the most expensive option but worthwhile if finances allow.

If you believe that you might have SAD please talk to your GP who can prescribe antidepressants or refer you to therapy.  Remember that SAD is more than winter blues that we all experience and can have detrimental effect on your quality of life for several months each year, thus it is certainly worthwhile getting adequate help and support.

Generalised Anxiety Disorder

DR JANA JENKINS explains what is Generalised Anxiety Disorder (GAD).

You are unlikely to be surprised that ‘Anxiety’ and ‘Worry’ are both very common but manageable for many people.

GAD on the other hand is characterised by excessive, uncontrollable and often irrational worry accompanied by high levels of apprehension about events or activities. Furthermore, people with GAD tend to be constantly preoccupied with their worries about health, money, death, family issues, interpersonal relationship problems, or work difficulties.  They anticipate that ‘something bad is going to happen’. This excessive worry causes significant distress and interferes with one’s daily functioning.

Excessive worry further results in many symptoms of anxiety which affects our body and can lead to many unpleasant physical symptoms such as palpitations, shallow or fast breathing, feeling nauseous, headaches, sweating or shaking.   Feeling tense and irritable, unable to relax, problems sleeping and difficulties with concentration. worry about anxiety itself are also common symptoms.

Most of us would have experienced some of these symptoms at some point.  However, for people who experience GAD, these symptoms can be persistent and severe and therefore understandably very distressing.

It is important to emphasise that ‘Anxiety’ is a normal reaction to danger and an important survival mechanism.  However, it can become a problem when our mind and body are constantly prepared for danger and get stuck in the ‘threat’ mode. For example, many people with GAD experience hypothetical worries (problem is not real but often imagined) such as ‘What if I get burgled or What if I or my loved ones get involved in a traffic accident and die?’, it is understandable that their bodies will produce a ‘fight or flight’ response to prepare for danger even though it is not real. Think about it like a test fire alarm, the sound is the same but there is no real danger of fire.

Most people I see who present with GAD experience unhelpful thoughts about their physical symptoms and they report being frightened by these symptoms.  For example, it is common that people think that there is something physically wrong with them, they are feeling ‘out of control’ or believe that they are going ‘mad’.  There is no wonder they may start fearing anxiety symptoms for such reasons.

If you live with someone with appears to have GAD, encourage them to get professional help.  From my clinical experience, it can be frustrating for the relatives who cannot make sense of irrational worries or need to constantly provide reassurance.  Try to be patient if you can and try to refrain from the phrase: ‘Don’t worry’ as GAD sufferers find it dismissive.  Also, try to avoid giving reassurance as it tends to keep anxiety going and reassurance is very short lived.

GAD can become disabling for many people as they start avoiding events and their life may become very restrictive.  If you think you may have GAD which is negatively impacting on your life, you may benefit from the evidence-based therapy (recommended by NICE guidelines) such as Cognitive Behavioural Therapy.




Self-Compassion and Why it is Important for Our Wellbeing

DR JANA JENKINS explains what is self-compassion and why it is important for our wellbeing

Self-compassion can be defined as self-kindness or having an ability to be warm towards oneself, especially at times of adversity.  In addition, another important facet of self-compassion is recognising that life is challenging.   Learning how to take a balanced approach to experiencing negative emotions and how to observe them with openness can be helpful.

Research shows that developing self-compassion increases our sense of well-being and general health.  You may be wondering why self-compassion can help your mental and physical health. Perhaps you are someone who tends to be hard on yourself and very self-critical. You may feel exhausted from being always on the go, judging yourself and being unable to switch off.

The good news is that self-compassion can be learnt.  You can master how to become more sensitive to your needs (e.g. the need for recognition and respect from others, the need for confidence, independence etc).

From my clinical experience, it is not uncommon that people struggle to identify their needs and recognise when they are not met.  Another tendency is to find it much easier to be kinder to others rather than to ourselves and adopt ‘double standards’ when it comes to kindness. For example, we are less likely to think of someone else as ‘useless’ when they make a mistake as opposed to judging ourselves when the same occurs.

The key aspect of self-compassion is learning how to tolerate, accept and become less frightened of our feelings.

It is helpful to know that our experiences of emotions emerge from the patterns created in our brains and bodies. It is useful to think about operating within three different systems; threat, incentive and soothing system.  Let me explain their different functions.

The function of the threat system is to pick up on threats quickly and generate feelings such as anxiety which then alerts and urges us to act against the threat and to self-protect.   Our brains can over-estimate threats because that’s how they are designed to work.

The incentive system is important to give us positive feelings that guide, motivate and encourage us to seek out things and resources in order to survive and prosper. We are motivated and pleased by seeking out, consuming and achieving nice things (e.g. food, places to live, comforts, friendships, etc). It will not surprise you that in modern societies this system becomes overstimulated and can lead to feeling overwhelmed.

Operating in the soothing system on the other hand results in feelings of contentment, social affiliation and peacefulness.  Many people struggle with self-compassion because cultivating self-compassion is not easy and we need to practice it and prioritise it. We all need time to stop, reflect, process our feelings, be with loved ones, have a cuddle and sometimes just simply ‘be’ rather than always ‘do’.

Noticing when we are harsh on ourselves and judging our feelings can be helpful. Noticing when we are not kind to ourselves is also beneficial; perhaps we are overworking, not sleeping enough, pleasing others but not recognising our needs.

When we practice meditation, mindfulness and ‘slowing down’, we are not concerned with wanting or striving, we tend to feel more connected with others and contented.  Many people I see are striving to achieve this sense of contentment and it is their lifelong ambition to achieve this state.

Do you think that you may be someone who can benefit from self-compassion?  What is the one thing that you can change to become kinder to yourself?